<div>
    <form role="patcase" ng-controller="EvaluationDataTableController"
          ng-submit="finishEditEvaluation(servReq._customCareCase)">
        <div class="modal-header">
            <button ng-if="showCloseBtn" type="button" class="close" ng-click="cancel()">
                <span class="icon icon-close" aria-hidden="true"></span>
            </button>
            <h4 class="modal-title" id="myModalLabel"><span translate="user.evaluation"> </span></h4>
        </div>
        <div class="modal-body">
            <div class="panel panel-default">
                <div class="panel-heading">
                    <h4><span translate="business.navtitle.patinfo"></span></h4>
                </div>
                <div class="panel-body">
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label>
                                <span translate="user.realname"></span> :
                            </label>
                            <span>
								{{servReq._patCase._patient._user.realName}}
							</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label>
                                {{"user.age" | translate }} :
                            </label>
                            <span>
								{{servReq._patCase._patient._user.age}}
							</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label>
                                <span translate="user.gender" ng-model="servReq._patCase._patient._user.gender"></span>
                                :
                            </label>
                            <span>{{('user.gender.' + servReq._patCase._patient._user.gender) | translate}}</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label>
                                <span translate="business.servreq.id"></span> :
                            </label>
                            <span>
								{{servReq.servReq_Id}}
							</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label>
                                <span translate="about.telephoneName"></span> :
                            </label>
                            <span>
								{{servReq._patCase._patient._user.mobile_Phone}}
							</span>
                        </div>
                    </div>
                    <div class="col-sm-6">
                        <div class="form-group">
                            <label>
                                <span translate="business.patcase.disease_type"></span> :
                            </label>
                            <span>{{('business.patcase.disease_type_' + servReq._diseaseType.desc) | translate}}</span>
                        </div>
                    </div>
                </div>
            </div>
            <div class="panel panel-default">
                <div class="panel-body">
                    <div class="form-group">
                        <label><span translate="business.evaluation.pain_Level"></span></label>
                        <div class="lanrentuku2">
                            <label class="btn btn-default" style="min-width: 32.5%; margin-bottom: 5px;"
                                   ng-model="pain_Level" btn-radio="1">
                                <i class="fa fa-check text-active"></i>1(<span
                                    translate="business.servreq.mild_pain"></span>)</label>
                            <label class="btn btn-default" style="min-width: 32.5%; margin-bottom: 5px;"
                                   ng-model="pain_Level" btn-radio="2">
                                <i class="fa fa-check text-active"></i>2</label>
                            <label class="btn btn-default" style="min-width: 32.5%; margin-bottom: 5px;"
                                   ng-model="pain_Level" btn-radio="3">
                                <i class="fa fa-check text-active"></i>3</label>
                            <label class="btn btn-default" style="min-width: 32.5%; margin-bottom: 5px;"
                                   ng-model="pain_Level" btn-radio="4">
                                <i class="fa fa-check text-active"></i>4</label>
                            <label class="btn btn-default" style="min-width: 32.5%; margin-bottom: 5px;"
                                   ng-model="pain_Level" btn-radio="5">
                                <i class="fa fa-check text-active"></i>5</label>
                            <label class="btn btn-default" style="min-width: 32.5%; margin-bottom: 5px;"
                                   ng-model="pain_Level" btn-radio="6">
                                <i class="fa fa-check text-active"></i>6</label>
                            <label class="btn btn-default" style="min-width: 32.5%; margin-bottom: 5px;"
                                   ng-model="pain_Level" btn-radio="7">
                                <i class="fa fa-check text-active"></i>7</label>
                            <label class="btn btn-default" style="min-width: 32.5%; margin-bottom: 5px;"
                                   ng-model="pain_Level" btn-radio="8">
                                <i class="fa fa-check text-active"></i>8</label>
                            <label class="btn btn-default" style="min-width: 32.5%; margin-bottom: 5px;"
                                   ng-model="pain_Level" btn-radio="9">
                                <i class="fa fa-check text-active"></i>9(<span
                                    translate="business.servreq.severe_pain"></span>)</label>
                        </div>
                    </div>
                    <div class="form-group">
                        <label><span translate="business.evaluation.compare_Previous"></span> : </label>

                        <div class="lanrentuku">
                            <button style="width:49%;" type="button" ng-model="compare_Previous"
                                    ng-model="radioModel" btn-radio="'yes'"
                                    class="btn btn-default" id="aa" ng-click="setCompare_Previous('yes')">
                                <i class="fa fa-check text-active"></i>
                                <span translate="business.evaluation.remit"></span>
                            </button>
                            <button style="width:49%;" type="button" ng-model="compare_Previous"
                                    ng-model="radioModel" btn-radio="'no'"
                                    class="btn btn-default" id="bb" ng-click="setCompare_Previous('no')">
                                <i class="fa fa-check text-active"></i>
                                <span translate="business.evaluation.nonremission"></span>
                            </button>
                        </div>
                    </div>

                    <div class="form-group">
                        <label><span translate="business.evaluation.service_Satis"></span></label>

                        <div class="lanrentuku1">
                            <label class="btn-fix btn btn-default" style="min-width: 24.4%;"
                                   ng-model="service_Satis" btn-radio="'VeryGood'">
                                <i class="fa fa-check text-active"></i>{{'business.servreq.satis_VeryGood' | translate}}</label>
                            <label class="btn-fix btn btn-default" style="min-width: 24.4%;"
                                   ng-model="service_Satis" btn-radio="'Good'">
                                <i class="fa fa-check text-active"></i>{{'business.servreq.satis_Good' |
                                translate}}</label>
                            <label class="btn-fix btn btn-default" style="min-width: 24.4%;"
                                   ng-model="service_Satis" btn-radio="'Normal'">
                                <i class="fa fa-check text-active"></i>{{'business.servreq.satis_Normal' |
                                translate}}</label>
                            <label class="btn-fix btn btn-default" style="min-width: 24.4%;"
                                   ng-model="service_Satis" btn-radio="'NotGood'">
                                <i class="fa fa-check text-active"></i>{{'business.servreq.satis_NotGood' | translate}}</label>
                        </div>
                    </div>

                    <div class="form-group">
						<textarea rows="3" style="resize: none;" class="form-control"
                                  ng-model="feedback"
                                  placeholder="{{ 'business.evaluation.feedback' | translate }}">
						</textarea>
                    </div>
                </div>
            </div>
        </div>
        <div class="modal-footer">
            <span ng-if="finished != false" class="pull-left"
                  translate="business.evaluation.evaluationCompleted"></span>
            <a ng-if="finished == false" class="btn btn-default" ng-click="cancel()">{{ 'common.cancel' | translate
                }}</a>
            <button ng-if="finished == false" class="btn btn-success" type="submit" translate="user.evaluation">Submit
            </button>
        </div>
    </form>
</div>